BBR World Finals Race/PBRIP Side Pot Form (CC option)

BBR World Finals Race/PBRIP Side Pot Form

The recorded owner of horse must be a current member and the rider/exhibitor must be a current APHA member. The BBR World Finals Race Side Pot will be $2,0000 added to the Coliseum Run side pot, and the entry fee is $100.
Rider Information
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
APHA Member ID #*
YesNo
APHA Membership Type*
Email*
example@example.com
Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Birthdate*

MonthDayYear
Date
SSN #
Horse Information
Horse Name*
APHA Registration Number*
Event Information
PBRIP Entry Fee
$100.00
One-time entry fee for Coliseum Run ONLY.
Disclaimer of Liability
I hereby release the BBR, its officers, employees, members, agents, representatives, and/or anyone else from any claim or right for damages which may occur to me, my horse, my child, or other property at this event or in transit. I realize there are certain risks in any activity of this nature, and I assume full responsibility for my safety and that of my horse. I have read, understand, and agree to abide by all BBR rules. By signing below, I acknowledge this release of liability.
Signature*

Clear
Payment
Subtotal
Transaction Fee
Total Due

Total Due

USDPBRIP Entry Fee

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

BBR World Finals Race/PBRIP Side Pot Form